Download Using this template - IRIS Early Intervention in Psychosis

Schizophrenia
Implementing NICE guidance
2009
NICE clinical guideline 82
Updated guidance
This guideline updates and replaces:
‘Schizophrenia: core interventions in the treatment
and management of schizophrenia in primary and
secondary care’ (NICE clinical guideline 1 [2002])
‘Guidance on the use of newer (atypical)
antipsychotic drugs for the treatment of
schizophrenia’ (NICE technology appraisal guidance
43 [2002])
What this presentation covers
Background
Scope
Key priorities for implementation
Costs and savings
Discussion
Find out more
Background (1)
• Schizophrenia is a major psychiatric disorder or cluster of
disorders, characterised by psychotic symptoms.
• About 1% of the population will develop schizophrenia.
• The first symptoms tend to start in young adulthood.
• A diagnosis of schizophrenia is associated with stigma, fear and
limited public understanding.
• There is a higher risk of suicide.
Background (2)
• Recent emphasis on early detection and intervention services.
• After an acute episode there are often problems such as:
- social exclusion
- fewer opportunities to return to work or study
- problems forming new relationships
• Most people recover, although some have persisting difficulties or
remain vulnerable to future episodes.
• Carers, relatives and friends are important during
assessment and delivery of effective treatments.
Scope
Treatment and management of schizophrenia and
related disorders.
Adults with an established diagnosis (with onset before
age 60).
Does not address the specific treatment of people under
18, except those receiving treatment and support from
early intervention services.
Access and engagement (1)
Healthcare professionals should ensure competence in:
•Working with people from diverse ethnic and cultural backgrounds:
- Assessment skills
- Using explanatory models of illness
• Addressing cultural and ethnic differences:
- In treatment expectations and adherence
- In beliefs regarding biological, social and family influences
on the causes of abnormal mental states
Access and engagement (2)
Healthcare professionals should ensure competence in:
• Explaining the causes of schizophrenia and treatment options
• Negotiating skills for working with families of people with
schizophrenia
• Conflict management and conflict resolution
Access and engagement (3)
• Mental health services should work in partnership with local
stakeholders (including those representing BME groups) to
enable access to local employment and educational
opportunities.
• Work with agencies, such as Jobcentre Plus, disability
employment advisers and non-statutory providers should be
sensitive to the person’s needs and skill level.
Access and engagement (4)
Identify a lead healthcare professional to monitor and review:
• access to and engagement with psychological interventions
• decisions to offer psychological interventions
• equality of access across different ethnic groups.
Primary care and physical health
GPs and other primary healthcare professionals should:
- Monitor physical health at least once a year
- Focus on cardiovascular disease risk monitoring
People with schizophrenia are at higher risk of cardiovascular
disease than the general population
A copy of the results should be:
- Sent to the care coordinator and/or psychiatrist
- Put in the secondary care notes
Psychological interventions
• Offer cognitive behavioural therapy (CBT) to all people with
schizophrenia.
• Offer family intervention to all families who live with or are in close
contact with the service user.
• Both can be started either during the acute phase or later, including
in inpatient settings.
Pharmacological interventions
•For people with newly diagnosed schizophrenia offer oral
antipsychotic medication
• Provide information and discuss the benefits and side-effect profile
of each drug offered with the service user
• The choice of particular antipsychotic drug should be made by the
service user and healthcare professional together, considering:
– the relative potential to cause extrapyramidal,
metabolic and other side effects
– the views of the carer (if the service user agrees).
Pharmacological interventions
Do not initiate regular
combined antipsychotic
medication except for short
periods, for example, when
changing medication.
Interventions for people with
schizophrenia whose illness has not
responded adequately to treatment
• Review the diagnosis.
• Check adherence to antipsychotic medication, and the dose and
duration.
• Review engagement with and use of psychological treatments.
• If family intervention undertaken suggest CBT.
• If CBT undertaken suggest family intervention for people in close
contact with their families.
• Consider other causes of non-response.
Interventions for people with
schizophrenia whose illness has not
responded adequately to treatment
Offer clozapine to people with schizophrenia whose
illness has not responded adequately to treatment
despite the sequential use of adequate doses of at least
two different antipsychotic drugs. At least one of the
drugs should be a non-clozapine second-generation
antipsychotic.
Arts therapy
Consider offering arts therapies to all people with
schizophrenia, particularly for the alleviation of negative
symptoms. This can be started either during the acute
phase or later, including in inpatient settings.
Costs and savings
The guideline on schizophrenia is unlikely to result in a
significant change in resource use in the NHS. However,
recommendations in the following areas may result in
additional costs/savings depending on local circumstances:
• race, culture and ethnicity
• pharmacological interventions
• psychological and psychosocial interventions.
Discussion
•
How do current staff competencies match those described in the
recommendations? How are cultural aspects addressed?
•
How well do current links with stakeholder organisations support
employment and educational links?
•
How can the quality and number of annual health checks carried
out on people with schizophrenia be improved?
•
How do we measure access to, uptake of and outcomes for CBT
and family-based interventions?
•
How well does current prescribing practice match the new
recommendations?
Find out more
Visit www.nice.org.uk/CG82 for:
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the guideline
the quick reference guide
‘Understanding NICE guidance’
costing template and costing statement
audit support
guide to resources